It only took one message from a follower after linking a lip balm I loved and was on my second tube of “$55 for a lip balm?!!”. I sat starting at that message. Reading it over and over. Would I have bought this with my own money???

For a long time, I had a simple standard for what I would share with you: I had to genuinely believe in the formulation.

That felt like enough. If a brand sent me something, I would look at the ingredient list, assess the formula, consider the skin concerns it was designed for, use it on my own skin for at least 2 weeks, and if it checked out clinically, I would share it. I was not recommending things I thought were ineffective. I was not sharing products I had any concerns about. My clinical judgment was the filter I tested through, and I felt really good about that.

Then something started happening that I couldn’t ignore.

The Moment That Changed Things

I would share a product I had been testing and loving, something I thought was truly a great formula — and when I went to link it, I would see the price and feel a flicker of something I can only describe as hesitation. And it wasn’t at all because the product was bad in any way, it was because I was looking at a cleanser for $90, or a serum for $220, or a moisturizer for $180, and asking myself honestly: would I pay this if nobody sent it to me?

Sometimes the answer was yes. Often it was more complicated than that.

The issue is not that expensive products cannot be worth it. Some of them absolutely are. The issue is that I was recommending things based on what was in them without fully accounting for whether the value proposition made sense at that particular price point — and whether I, knowing what I know, would actually hand over my own money for them.

That is a different question than “is this a good formula?” And I had not been asking it of myself before posting.

The Standard I Set for Myself

So I changed my approach.

The new rule was straightforward: if I would not buy it myself, completely out of pocket, without hesitation, I do not recommend it. Not as an affiliate. Not as a mention. Not as a passing reference. If my own money would not go toward it, I wasn’t going to encourage yours to either.

This meant turning down more and more PR. It meant being more selective about what I linked. It meant that my ShopMy collections got smaller and smaller before they got better. And it meant that I started actually purchasing more of the products I recommend — paying full price, out of my own pocket, and using that transaction as the final filter.

There is something clarifying about spending your own money. When you are receiving products for free, even with the best intentions, there is a subtle buffer between you and the full reality of your views on said product. When you buy something yourself, that buffer disappears. You feel the price. You consider the alternatives. You weigh whether the formula justifies what is on the tag. And your recommendation comes from a completely different place.

What This Looks Like in Practice

The categories where I had to recalibrate most were the ones where PR flows most freely — luxury serums, high-end cleansers, premium moisturizers in the categories where the drugstore and mid-range alternatives perform as well or better.

There are products in the $150 to $300 range that I think are worth every dollar of that price — ingredients that are differentiated, formulations that are superior, technologies that justify a premium. I still recommend those. But I buy them myself first, and the recommendation comes after that purchase, not before.

There are also products I received and shared in the past that I would not pay for at their actual price point. Not because they were ineffective, but because the formulation did not justify the cost when you know what you are looking at. I stopped sharing those.

The categories where I have become most skeptical of high price points: cleansers, basic moisturizers without truly differentiated actives, and anything in a category where clinical evidence and ingredient technology does not scale with price the way marketing suggests it does. The categories where I think premium pricing can be genuinely warranted: sophisticated active formulations, technologies with real clinical data behind them, devices.

Why I Am Telling You This

Because I think you deserve to know the standard I am holding myself to.

The skincare and beauty content space has a complicated relationship with honesty around product recommendations. PR, gifting, affiliate commissions, paid partnerships (that’s not even getting into the crazy PR stunts and lavish brand trips some brands pull)— all of these create incentives that are not always aligned with the person asking for your recommendation. Most creators are not recommending things they think are bad. But there is a lot of space between “I think this is good” and “I would spend my own money on this without hesitation.”

I want to operate in that second category. Not because it makes me a better “expert”, but because it makes me a more trustworthy one — and what I’ve learned from going viral in the past is trust is the only currency in this space that actually matters to me.

When you see me recommend something, I want you to know that it passed the test that matters most to me: I paid for it, I use it, and I think the money is well spent. If I received it as PR, I will tell you that. And I will only tell you about it if I would have bought it anyway.

That is the standard.

You can rest assured that any product I mention has passed this test and checking out our Skinthusiast Selects is a great place to start! And if you liked this post I think you’ll really like this one about why your vitamin C isn’t doing what you think it is!

If you are not ready to subscribe yet, the free posts are a good place to start. Either way, I am glad you are here. 👇

I’m going to give you a real reason.

I’ve had both treatments personally and I perform aesthetic treatments in clinic. So I understand the science behind both technologies. Here’s my honest take — and after experiencing both firsthand, I have a clear opinion.

Let’s get into it.

First: What They Both Do

Both Ultherapy and Sofwave use ultrasound energy to create a controlled thermal injury in the skin — triggering your body’s wound-healing response, which stimulates new collagen and elastin production. The goal with both is the same: tighter, firmer, more lifted skin without surgery or downtime.

That’s where the similarities end.

The Technology Difference — And Why It Actually Matters

This is the part most comparison articles gloss over, so I want to spend a minute on it because it explains almost everything else — the pain, the risks, the results, the experience.

Ultherapy delivers micro-focused ultrasound energy at multiple depths, including the deep SMAS layer at 4.5mm — the same depth targeted in surgical facelifts. That deeper energy delivery contributes significantly to its pain profile and carries risks including temporary numbness, nerve irritation, and subcutaneous fat loss in rare cases.

Sofwave’s SUPERB technology takes a different approach, delivering parallel beams of ultrasound energy focused at 1.5mm into the mid-dermis, where collagen production is most concentrated. The idea is that this focused approach produces comparable tightening results, because the vast majority of facial collagen resides at this depth, without having to go deeper.

In plain terms: Ultherapy goes deeper, assumes deeper is better, and delivers a more aggressive treatment with a higher risk profile. Sofwave focuses at the depth where the collagen lives.

You now know what separates these two technologies at the clinical level. What comes next is the part you actually came here for — my personal pain experience with both treatments, the fat loss risk conversation, the real cost breakdown, and my honest recommendation after being on both tables. All of that is below for paid subscribers.

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The problem is that it is rarely as powerful as people imagine in the context of hyperpigmentation — and it is never a standalone treatment. I watch patients spend months faithfully applying a Vitamin C serum and wondering why their dark spots aren’t moving, and the answer is almost never that they need a different Vitamin C. It’s that they’re relying on one ingredient to do a job that requires a complete protocol, and nobody told them that.

This post is me telling you that.

What Vitamin C Actually Does for Hyperpigmentation

Vitamin C works on hyperpigmentation through a few different mechanisms, and it’s worth being specific about each one because they are not all equal in strength.

At the enzymatic level, vitamin C interacts with tyrosinase — the enzyme responsible for driving melanin production — by binding to its copper component and reducing its activity. This can help surface-level discoloration and sun damage. A 2004 randomized trial comparing 5% ascorbic acid to 4% hydroquinone in melasma patients found that vitamin C produced meaningful improvement — though hydroquinone still outperformed it. That study matters because it confirms vitamin C does in fact work on hyperpigmentation, while also making clear that it sits below the gold standard in potency.

Beyond that direct mechanism, vitamin C is one of the most well-studied antioxidants in skincare. UV exposure and oxidative stress are primary drivers of melanocyte activation — they trigger the cascade that produces dark spots in the first place. A well-formulated vitamin C serum applied in the morning works as a buffer against that damage before it has a chance to set off the pigmentation process. This is prevention layered on top of mild treatment. And if you listen to anything I say- you know that prevention is worth more that treatment any time.

Vitamin C also enhances the photoprotective effect of sunscreen when the two are used together, which is one of the most well-supported pairings in skincare. This synergy is unmatched!!

So to be clear: vitamin C does do something for hyperpigmentation. The issue is that its depigmenting effect is mild to moderate, it’s highly dependent on how well the formula is stabilized, and it’s not designed to be a standalone treatment— particularly for melasma, hormonal pigmentation, and post-inflammatory hyperpigmentation that has been sticking around for months.

A label that says “brightening” or “evens skin tone” is not wrong. But it describes a benefit that works best as part of a complete protocol, not as a substitute for one.

Vitamin C earns its place in a hyperpigmentation routine — it just cannot carry the whole protocol on its own. The clinical explanation for why, and the full treatment framework that addresses hyperpigmentation at every level, is below for paid subscribers.

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About two weeks ago I had an allergic reaction to a laundry detergent. The reaction started on my chest and quickly moved to the full body down my abdomen, arms, legs and up my neck and face. So, I had to stop everything! And by everything I mean everything. No retinoid. No vitamin C. No peel pads. No actives of any kind. My skin was so reactive that even my usual products I’ve used for years were burning and stinging, so I stripped back to the most minimal routine I could manage and waited it out.

What I didn’t expect was what happened on the other side of it.

14 Days of Nothing

I’ve written before about my “skin reset” philosophy — the idea that sometimes the most powerful thing you can do for your skin is remove everything and let it breathe. I believe in it clinically and I recommend it to patients all the time. And yet, like most providers, I am probably the worst patient when it comes to following my own advice.

This time I didn’t have a choice.

For about 14 days I used just three things.

A gentle oil cleanser with gentle and barrier-supportive ingredients with no actives and no fragrance.

A peptide moisturizer which has ceramides, peptides, and niacinamide — everything my barrier needed and nothing it didn’t.

A mineral SPF only on the days I was going outside without anything that would stress an already reactive skin situation.

That was my entire routine. No serum, no retinoid, no exfoliant, nothing that was working toward any goal except keeping my skin calm, hydrated, and protected.

What I Didn’t Expect

My skin is the clearest it has been in months. Not just recovered from the reaction — actually clearer than it was before the reaction happened. The redness I had been managing for the better part of two years feels more settled than ever. The hyperpigmentation I had been treating since pregnancy started clearing in a way I hadn’t seen in a long time. I didn’t necessarily think I had much skin texture before, but now feeling my face this smooth, it’s crazy. Before pregnancy I wore non-tinted sunscreen all the time with zero makeup. While I still prefer a tinted formula for visible light protection- I feel like my comfort level is back to that care free truly no makeup Amy.

Here’s what I think happened.

The Clinical Explanation

Pregnancy and breastfeeding put your hormones through significant fluctuations — estrogen, progesterone, prolactin — all of which influence melanocyte activity, sebum production, and skin barrier function. Melasma, post-inflammatory hyperpigmentation, sensitivity, and breakouts are all extremely common in the postpartum period for this reason, and my skin has been navigating the aftermath of two pregnancies for the better part of 4 years.

My skin was certainly in a pretty good state with my current routine. Being a clinician obviously gives me the upper hand when it comes to managing all these skin complaints. But the allergic reaction threw me off kilter.

Here is what I think the reset actually did.

It lowered my baseline inflammation. Every active ingredient, even when used correctly, introduces some level of irritant potential. For skin that is already dealing with hormonal fluctuation and an elevated inflammatory baseline, that cumulative load adds up in ways that are easy to miss because the changes are gradual. 14 days without any of it gave the inflammation somewhere to go.

It gave my barrier time to fully rebuild. A well-managed active routine still creates some degree of ongoing barrier disruption — not enough to cause visible damage, but enough to keep the barrier in a state of constant repair. With nothing disrupting it, the barrier had time to actually strengthen rather than just perpetually play catch-up.

Hyperpigmentation is driven by inflammation — it is literally the skin’s response to injury and irritation. When you are running actives consistently, you are simultaneously working to fade pigmentation and (sometimes) creating the low-level inflammation that can keep perpetuating it. Removing that cycle entirely, even for a short time, gave the existing hyperpigmentation a chance to settle.

This reset showed me my baseline. There is real clinical value in knowing what your skin actually looks like without anything on it. I had gotten so deep into the treatment phase of my routine that I had lost track of my starting point, and this reset gave it back to me.

What This Means Going Forward

I am bringing my actives back slowly and thoughtfully, one at a time. My position on retinoids, vitamin C, and the ingredients I have always recommended has not changed — the clinical evidence is the same. But I am returning to them with a better understanding of where my skin actually is right now, with my barrier intact and my inflammation at its lowest point in years. Actives land differently on healthy skin, and I want to take advantage of that.

What I could not have predicted going into this is how much my skin was still adjusting to everything my body went through during pregnancy and breastfeeding, and how much the pressure of a consistent active routine (eve a very simple one)

was working against that adjustment rather than alongside it. Starting fresh changes the equation.

I also cannot stop thinking about the fact that I have been recommending the skin reset to patients for years, have written about it, and believed in it clinically — and it took an accidental full-body allergic reaction for me to actually do it on myself. There is something both humbling and clarifying about that.

I am planning to build a quarterly reset into my routine from now on, on purpose, without waiting for a skincare emergency to force it. Moving forward, once every 3 or 4 months, I’ll do two weeks stripped back to the essentials before moving into the next phase of treatment. Based on what I just experienced, I think it is one of the most valuable things I can do for my skin long-term.

It is, without question, the most unexpected skincare lesson I have given myself.

If any of this sounds familiar — and if you have ever had the feeling that your skin might need a break from your routine — I have a full clinical breakdown of the skin reset protocol: why it works, exactly how to do it, and how to reintroduce your actives without undoing the reset. That post is for paid subscribers and you can find it [here].

Not ready to subscribe yet? The free posts are a great place to start, there’s so much value there. Either way, I’m glad this one found you. 👇

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The chicest women I see aren’t the ones who look the most “done.” They’re the ones letting their Botox wear off. They have expression lines. They smile and their eyes crinkle and they look — refreshingly, almost startlingly — human.

And I say that as someone who injects for a living.

How We Got Here

Let’s go back to the early days of injectable aesthetics. Botox was a privilege. Getting it done well was expensive, skilled, and relatively rare. It was a refinement. It was a subtle softening of the lines that bothered you most, subtle enough that nobody could quite put their finger on what was different. You just looked rested. Polished. Like yourself, but on a good day.

Then it got cheaper. More accessible. More widely available. Medspa culture exploded, price competition intensified, and somewhere along the way the goal shifted. What was once designed to lessen and refine became freeze my face entirely. Units went up. Frequency went up. The treatment that was supposed to make you look like the best version of yourself started making everyone look like a slightly different version of the same person.

The “Instagram face” aesthetic — you know the one with the super arched brows, the forehead that doesn’t move a millimeter, the pillowy cheeks — became so ubiquitous it stopped reading as beauty and started reading as procedure. And once everyone could spot the procedure, the mystique was gone.

This is almost exactly what happened with bare nails. For years, a polish-free nail was considered unfinished, unprofessional, an afterthought. Then gel became so accessible and so uniform that the highly maintained set started to look labored. Now the chicest thing you can wear on your hands is a clean, bare, well-shaped nail. The flex became effortlessness. The status moved to the natural.

Botox is having its bare nail moment.

The Real Cultural Shift

Here’s what I think is actually driving this — and it goes deeper than just aesthetics.

We are living in the age of AI. Every image we consume is increasingly suspect. Every face in an ad may be generated. Every voice on a video may be cloned. Filters, retouching, digital manipulation — we are swimming in a sea of artificial, and somewhere in our nervous systems, we are exhausted by it.

A real human face — with lines that move, with expressions, with the visible evidence of a life actually lived — has become something genuinely rare. And rare things have become valuable.

The movement isn’t anti-aesthetic. It’s pro-authenticity and expression. The women I see letting their Botox wear off aren’t “giving up” on how they look, nor are they “quitting Botox” forever, at least not all of them. They’re making a different statement about what looking good actually means. They want to look like themselves. Not frozen. Not optimized into something generic. Themselves — just better skincare, better sleep, better health. The version of you that someone would recognize in ten years.

That is the new luxury. Not the absence of aging, but the confidence to let your face move.

What This Means for the Industry — My Predictions

I want to be clear: Botox is not going away. The clinical evidence for targeted neuromodulator use is strong and the treatments, in the right hands, remain truly valuable. But the way people use it is changing — and I think we’re only at the beginning of that shift.

Here’s what I think it all means in practice:

Fewer units, longer intervals. The demand I’m seeing is for microdosed treatments — less product, less frequently, for a milder effect that doesn’t eliminate expression. People want to soften, not freeze. The tradeoff: lower doses mean shorter duration. You’re not going to get four to six months out of a baby Botox treatment the way you might with a full dose. For most people who are consciously moving away from the frozen look, that’s a welcome trade.

Expression as the goal. “I still want to be able to raise my eyebrows” is something I now hear in almost every consultation. And increasingly “I don’t mind seeing a few wrinkles” That would have been an unusual request five years ago. Now it’s the default. The “freeze my face” patient is increasingly the exception.

Skin quality over volume. 2025 and 2026 are about restoration over inflation — fewer syringes, smarter stacks, and skin-first approaches. The patients who used to book filler every six months are now asking about skin tightening, at-home microcurrent, laser, microneedling red light, devices — treatments that improve the skin’s actual quality rather than adding something to it. I’ve written about this in my filler post and I’ll keep writing about it because the shift is real and significant.

Longer gaps between treatments. The two-to-three times per year cadence that became standard is quietly stretching. People are waiting to see what they actually look like when it wears off completely — and some of them are deciding they like it.

What I Tell My Patients

When someone comes in and says they’re not sure they want to keep doing what they’ve been doing — that they want to look a little more like themselves — I don’t try to talk them out of it.

I think that instinct is worth listening to.

What I do try to redirect is the all-or-nothing thinking that comes with it. You don’t have to choose between frozen and untreated. There is a lot of room between those two things — room for conservative doses in specific areas, for longer intervals, for a treatment plan built around what you actually want rather than what the protocol suggests. BUT if a patient wants to skip the tox all-together. I am their cheerleader. I’m there to suggest other options to help refresh. This doesn’t come as a surprise to them since I’ve always taken a skincare first approach.

The best aesthetic outcome is always the one that makes you feel like the most recognizable, refreshed version of yourself. Sometimes that includes Botox. Sometimes it doesn’t. Increasingly, for a lot of women, it means a lot less of it than they used to use.

And honestly? Some of the most striking faces I’ve seen in my clinic (and out in the world) lately are the ones with the crow’s feet still there. The ones with the forehead lines that move when they talk. The ones that look — I keep coming back to this word — human.

In a world full of artificial everything, that is the plot.

I’m writing about where aesthetics is actually headed — the treatments worth your time and money and the ones that aren’t — every week on The Extra Step. If this resonated, the next post goes deeper on the new aesthetic treatment pyramid: what I think will replace the filler-first model and why devices are no longer optional. You can read it [here] with a paid subscription — or start with the free posts. Either way, I’m glad you’re here. 👇

If you read the Skin Reset post, you already know the philosophy: strip it back, three steps, no exceptions. Gentle cleanser, moisturizer, SPF, that’s the framework for everyone.

But “gentle cleanser” and “barrier-repairing moisturizer” look pretty different depending on what your skin actually needs. So this is the part I promised, the exact AM and PM …

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Somewhere between the tenth new product launch of the month, the three-step exfoliation routine, the retinoid you started too fast, and the travel that wrecked your moisture barrier, your skin BROKE. Not catastrophically. But enough. It’s breaking out, or burning when you apply things that never used to sting, or just generally staging a protest against everything you’re putting on it.

I see this every single week in clinic. And every single time, my answer is the same.

Strip it back.

That’s the skin reset. It’s not a product line. It’s not a trend. It’s a clinical philosophy I use with patients and on myself — and it is the single most effective intervention for skin that’s breaking out, freaking out, or otherwise telling you it’s had enough.

Why Your Skin Gets to This Point

Before we talk about what to do, I want to quickly talk about why this happens, because understanding the mechanism makes the protocol make a lot more sense.

Your skin barrier is the outermost layer of the epidermis, and its primary job is to keep moisture in and irritants out. When it’s healthy and intact, your skin looks calm, feels hydrated, and can tolerate your actives without drama. When it’s compromised, the opposite happens. Water escapes more easily, your skin becomes reactive, and things that were previously fine start stinging, flaking, and breaking out.

Here’s the part most people miss: barrier damage is almost never one dramatic event. It’s a stacking effect. A little over-exfoliation here, a new product there, some travel, a season change, a week of inconsistent moisturizer, and then your skin hits a tipping point and suddenly everything is wrong.

The Most Common Culprits I See In Clinic:

• Over-exfoliation — by far the most common. AHAs, BHAs, retinoids, exfoliating pads, etc all have a legitimate place in a routine, but they should never all be running at the same time. If you’re using a retinoid most nights and adding a peel pad on top of that, and there’s a salicylic toner somewhere in the mix, your barrier doesn’t stand a chance.

• Harsh or aggressive cleansing — not just what you use but how you use it. Rough application, very hot water, that tight stripped feeling after washing that some people have been conditioned to interpret as “clean.” It isn’t clean. It’s compromised.

• Too many new products at once — even gentle formulas can overwhelm your skin when you’re introducing multiple new steps simultaneously. There’s a reason I always say introduce one product at a time and wait two weeks before adding another.

• Weather & environment — cold air, wind, and indoor heating in winter. Air conditioning in summer. Travel. These are all external barrier stressors your routine needs to account for.

• Skipping moisturizer & SPF — especially SPF. UV exposure increases inflammation, worsens dryness, and makes skin more reactive. Skipping it while you’re trying to repair your barrier is like trying to fill a bathtub with the drain open.

The Protocol: What the Skin Detox Actually Looks Like

When skin is actively irritated (burning, tight, red, flaky, breaking out in ways that feel angry rather than normal), this is the routine reframe.

Three steps. Morning and night.

Gentle cleanser. Moisturizer. SPF.

That’s it. That’s the whole thing.

I know that sounds almost offensively simple. But this is exactly the point, when your barrier is compromised, you are not in an optimization phase. You are in a repair phase. And repair requires removing the load, not adding to it.

Here’s how I think about each step:

The cleanser is your foundation and it matters more than people give it credit for. The goal is cleansed skin, not squeaky, tight, stripped skin. That sensation after washing means your cleanser took too much. For the skin detox period, I want a gentle, fragrance-free formula that cleanses without disrupting. If your skin is very dry or sensitive, you can skip the morning cleanse entirely and just splash with lukewarm water. Cleanse only at night. One thorough cleanse is enough when your barrier is struggling. Here are a few I might recommend depending on skin type.

The moisturizer is not optional and it’s not “extra.” When your barrier is compromised, moisturizer is part of the repair plan. What you want is something with ceramides, fatty acids, and cholesterol — these are the lipids that your skin barrier is literally made of, and replenishing them topically gives the skin what it needs to rebuild. Apply it while your skin is still slightly damp after cleansing. Here are some options that fit the bill.

SPF, even in a detox phase. Actually — especially in a detox phase. A compromised barrier is more vulnerable to UV damage than a healthy one. Every day you skip SPF while trying to repair is a day you’re actively working against yourself. If your skin is reactive, a mineral SPF — zinc oxide or titanium dioxide — is less likely to cause irritation than a chemical formula. Find one you like the feel of and use it every single morning.

That is your entire AM routine during a skin reset.

For PM, I add one thing: the double cleanse. If you’re wearing SPF daily — and you are — a single cleanse at night is not enough to remove it. Start with a cleansing balm or micellar water to break down the SPF and any makeup, then follow with your gentle water-based cleanser. Then moisturizer. That’s it. No actives. No retinoid. No exfoliant. Nothing else.

How Long to Stay in Detox Mode

This is the question I get most often, and the honest answer is: until your skin is no longer reacting.

For most people that’s at least two weeks. For skin that was significantly over-exfoliated or dealing with a product reaction, it might be 3+. You’ll know it’s working when the stinging stops, the flaking settles, and your skin starts to feel calm and even again.

The temptation at that point — and I’ve seen this so many times — is to immediately go back to everything at once because your skin feels better and you’ve missed your routine. Resist that. The right move is to reintroduce actives slowly, one at a time, with at least a week between each new addition. Your retinoid comes back first if that’s a priority, at a low frequency to start. Your exfoliant comes back eventually, but at a reduced cadence. You’re rebuilding the routine with intention, not just picking up where you left off.

When the Skin Detox Isn’t Enough

I want to be honest with you: the skin reset handles most situations, but not all of them.

If you’ve been in stripped-back mode for 4-6 weeks and your skin is still burning, still breaking out, still visibly red and reactive — that is a clinical situation. Contact dermatitis, perioral dermatitis, rosacea flares, fungal acne — these all present with symptoms that look like barrier damage but require a different intervention. If the detox isn’t moving the needle, please see your derm provider in person. It’s probably not just about your routine. We can help.

The Mindset Shift That Makes This Work

The skin reset only works if you actually commit to it — and that means resisting the urge to keep doing things to your skin while you’re waiting for it to calm down.

I watch patients do this all the time. Their skin is freaking out, so they research new products, try something they read about, add a “soothing” serum on top of the protocol (they’re almost never actually soothing). And then they’re surprised when nothing changes. Every new product is a variable. While your skin is compromised, you cannot tell what’s helping and what’s hurting. The reset works because it removes everything except the essentials — and the essentials are doing more than most people realize.

There’s a version of skincare that’s about having a routine you love using every day. And there’s a version that’s about results. The skin reset is squarely in the second category. Three steps, consistently, for two weeks — and I’d put that up against any elaborate ten-step routine for compromised skin every single time.

Have questions about the skin detox or what to reintroduce first when you’re ready to rebuild? Drop them in the comments — I read every one. And if you want the specific product recommendations I use for barrier repair organized by skin type, that breakdown is waiting for paid subscribers here.

I’ve dealt with increased shedding/thinning at various times throughout my life and postpartum shedding twice — after both of my daughters — and while postpartum hair loss is extremely common and typically self-resolving, it pushed me to build a real protocol rather than just recommending one to patients. Here’s what my actual stack looks like right now.

If this is the kind of content you enjoy, be sure to subscribe so you don’t miss the rest!

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Ok let’s get into it!

LED Hair Growth Helmet (code CBAMY for 10% off)

This is the device I recommend without hesitation for at-home red light therapy, and it’s the one I use personally. The reason I specifically recommend a helmet-style device over wands or smaller handheld tools comes down to the coverage point — you need full scalp exposure at the right wavelength for a meaningful duration. Theis helmet uses clinically studied 620–660nm wavelengths, covers the entire scalp simultaneously, and takes ten minutes. My husband and I put them on after the girls go to bed. It has become, unexpectedly, our nightly debrief ritual — which is also the most honest endorsement I can give any product. The things you actually use consistently are the things that work.

Consistency is the non-negotiable here. At least five nights a week in those first twelve to sixteen weeks. Most people start noticing changes around the twelve-week mark, which is exactly what the clinical protocols predict.

A hair density supplement. I have used both Nutrafol and Arey in the past: here’s the breakdown of each.

Nutrafol

I’ve used Nutrafol for years and it remains one of the few supplements in this category I recommend with confidence. The multi-targeted formulation — addressing follicle health, stress response, and hormone balance simultaneously — aligns with how I think about hair loss clinically. It’s not a silver bullet, but it’s one of the more substantiated options in a category full of noise.

Arey System (code AMY15)

I started this after my second daughter and noticed a meaningful improvement in my postpartum shedding compared to what I experienced after my first. The reason I like the Arey system specifically is that it addresses both thinning and greys simultaneously — which matters because those two things can often happen at the same time. The supplement plus scalp serum combination is a thoughtful approach, and the results have been real for me personally. Plus they have the clinical study to back it.

Protein and collagen

I want to say this clearly: no supplement stack is going to compensate for inadequate protein intake. Hair is primarily made of keratin — a structural protein. If your body doesn’t have the building blocks, it’s not going to prioritize hair growth. I add hydrolyzed collagen peptides to my coffee every single morning (no taste, no texture and minimal effort) and use a protein powder in my daily smoothie. This isn’t glamorous advice. It’s the unglamorous foundation that makes everything else work better.

The nutrients that matter most for hair: protein, iron/ferritin, zinc, B vitamins, and vitamin D. Get your levels tested before you supplement anything blindly. Targeted correction of an actual deficiency will do more than any stack of general wellness supplements.

Prenatal Multivitamin

Here’s one that might surprise you — and it’s one of my favorite recommendations even for women who aren’t pregnant and have no plans to be.

I take the Fullwell Prenatal as my daily multivitamin. Not because I’m pregnant, but because the nutrient profile of a well-formulated prenatal is frankly superior to most standard women’s multivitamins on the market — particularly for hair.

Here’s the thing about prenatals that most people don’t know: they’re formulated to support a body under enormous nutritional demand. Pregnancy depletes nutrients at an accelerated rate, so a good prenatal is designed to cover all the bases, in meaningful amounts, in forms the body can actually absorb. That nutrient density translates directly to hair health — because hair follicles are some of the most metabolically active cells in the body and among the first to suffer when your nutrition isn’t dialed in.

The Part Nobody Talks About: Protecting Your Ends

Here’s something that gets completely overlooked in the hair growth conversation: you can be doing everything right at the root and still not retain length if your ends are breaking off at the same rate you’re growing.

Hair growth is a two-part equation. Growing from the follicle is one half. Keeping what you grow is the other. If your ends are dry, damaged, or mechanically stressed, you are essentially running in place — and no amount of minoxidil or red light therapy changes that math.

This is why length retention is its own category in my routine, and why I’m genuinely evangelical about these four things:

Pre-shower hair oiling

Oiling before you shampoo rather than after is one of those switches that completely changes the game once you make it — and it’s counterintuitive enough that most people never try it. The reason it works: when you apply oil to dry hair before washing, the oil penetrates the hair shaft and reduces the amount of water that enters during shampooing. This matters because wet hair swells, and repeated swelling and contracting is one of the primary mechanisms of hair damage — the same internal structural stress I talked about in my air-drying post. Pre-oiling minimizes that swelling cycle, which means less breakage every single wash day.

Olaplex No. 3

Bond builders changed hair care in a real way, and Olaplex No. 3 is the one I come back to consistently. The active ingredient — bis-aminopropyl diglycol dimaleate — works by reconnecting broken disulfide bonds inside the hair shaft. These are the structural bonds that get damaged by heat, chemical processing, UV exposure, and mechanical stress over time. Reconnecting them from the inside makes the hair physically stronger, not just better-feeling superficially.

I use it once a week before shampooing, left on for at least ten minutes — longer if I have time. If your ends are dry, snapping, or generally unhappy, this is the first thing I’d add to your routine.

Silk pillowcase

This one sounds like a luxury purchase dressed up as a hair tip — but there’s real mechanics behind it. Cotton pillowcases create friction against your hair as you move during sleep. That nightly friction causes mechanical stress on the hair cuticle, leading to roughness, frizz, and over time, breakage — particularly at the ends and around the hairline where contact is greatest. A silk or satin surface reduces that friction, which means your hair is experiencing significantly less mechanical damage for the eight hours a night you spend sleeping on it. I’ve been sleeping on a silk pillowcase for years and I really notice the difference when I travel and don’t have one.

Heat protectant and continuous airflow tools

I covered this in depth in my air-drying post — the short version is that controlled heat from a quality tool with consistent airflow causes less damage than either uncontrolled heat or prolonged wetness. But no matter how good your tool is, a heat protectant is non-negotiable. It creates a film around the hair shaft that buffers against thermal damage and environmental stress simultaneously.

The tools that have made the biggest difference in my own routine are those with continuous, even airflow — the kind that dries hair uniformly rather than concentrating heat in one spot. Uneven drying means some sections are sitting damp while others are being over-dried, which creates inconsistent texture and unnecessary heat exposure. Even airflow, proper distance, a heat protectant applied before — that combination is what protects your ends while you style. For more on why blow drying is better for your hair than air drying you can read this post!

The goal with all of this is simple: grow from the root, keep what you grow. These four practices are what close the gap between those two things.

If you have specific questions about your personal hair growth journey be sure to drop them in the chat!

Also, I just wrote a post on how to build a step-by-step skin routine for all my paid subscribers! You can read it [here]

I’ll be upfront: I went into this one already knowing the science. I perform aesthetic treatments in clinic. I understand collagen stimulation, controlled thermal injury, and what ultrasound energy does at the dermal level. I wasn’t going in blind, and I had realistic expectations. This is something I think is often lacking in the aesthetic space because of the widely photoshopped before and afters we see on social media.

What I was going in for was an honest experience — one I could bring back to you with actual clinical context.

Here’s everything: what the treatment is, how it actually felt, what I used for pain management, where I am at eight weeks, and what the science says I should expect from here.

What Sofwave Actually Is & Why It’s Different

Sofwave uses something called Synchronous Ultrasound Parallel Beam technology — SUPERB™ — to target the mid-dermis, where collagen, elastin, and hyaluronic acid remodeling can be stimulated without injuring the skin surface.

Here’s the part that matters clinically: the applicator contains seven small transducers arranged in a single line. When triggered, all 7 deliver focused ultrasound simultaneously, each at the same depth of 1.5mm. The result is a wide band of dermal heating with each pass, rather than a single point of focused thermal injury.

That distinction is important. When the ultrasound waves penetrate the skin, they generate heat at specific depths, causing a thermal effect that leads to the denaturation of collagen fibers. This controlled thermal injury triggers a wound-healing response, prompting fibroblasts to produce new collagen and elastin fibers. In other words— the treatment creates a very precise, controlled injury at exactly the right depth, and your skin responds by building new structural proteins. You’re not replacing anything. You’re triggering your own biology to do what it stopped doing as efficiently on its own.

They also use what they call a SofCool cooling system to monitor skin surface temperature in real time, which is what makes this treatment (in my opinion) more comfortable than older ultrasound technologies — and what protects the surface of your skin throughout.

How It Compares to Ultherapy (Because Everyone Asks)

If you’ve heard of Ultherapy and you’re wondering how Sofwave stacks up: they both use ultrasound energy to stimulate collagen, but they work differently and feel a bit different.

Sofwave delivers parallel-beam ultrasound to the mid-dermis at 1.5mm — the ideal depth for collagen stimulation. Ultherapy delivers micro-focused ultrasound at multiple depths, including 4.5mm — the same depth targeted in surgical facelifts — which comes with a higher risk of discomfort, nerve irritation, and unintended fat loss. As a provider I can tell you I have more control with an Ultherapy machine (can go deeper or more superficial), but there is risk with that. With Ultherapy you have to know how to read ultrasound imaging and that’s not always easy to do.

Now that I’ve seen both and have talked to many provider friends who have used both as well, I do believe that sofwave is the way of the future, however, I think both have value. In other words, if you have a provider that you trust and feel you are in good hands but he or she only uses Ultherapy, go for it! In my opinion, it’s much more important that you have a trusting relationship with that provider than what specific device they’re using (this goes for any procedure in fact).

But, one more thing worth mentioning: Sofwave is more standardized in its delivery than some other ultrasound technologies, which makes it somewhat less provider-dependent. The fixed depth of 1.5mm removes some of the operator variability you’d see with a device that requires the provider to select multiple treatment depths. That said — having a good provider who knows what they’re doing still matters enormously with any cosmetic treatment. Don’t let “less provider-dependent” be your reason for skipping a consultation or choosing a clinic you haven’t vetted.

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Last week I told you about the acne flare that changed everything for me, and the philosophy it left me with: simplicity first, consistency over complexity, lifestyle counts, and patience is non-negotiable.

Now I love sharing what I believe, when it comes to skincare. But the truth is, what I actually get asked in the DMs, in the comments, in the consult…

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I think there’s this unspoken assumption that anyone working in dermatology has never really struggled with their skin. Like somehow the credential comes with a lifetime of clear, glowing skin.

I want to clear that up RIGHT. NOW.

My passion for skincare didn’t start in a classroom or a clinic. It started in 2015, standing in front of a bathroom mirror, exhausted and frustrated, watching cystic pimples spread across my cheeks, jawline, neck, and behind my ears.

I was a Critical Care PA at the time, my schedule was brutal. I’m talking seven 12-hour night shifts in a row, running on adrenaline and whatever was left in the vending machine. The stress was debilitating (to say the least). And my skin, which had always been relatively clear, was paying the price in a way I had never experienced before.

What made it harder was that the resources just weren’t there yet. Skincare on social media was in its early days. There weren’t many dermatology professionals with a platform, and the information that did exist was scattered, overwhelming, and rooted from trends rather than science. I pieced together what I could, combining what I was learning from early skincare communities with the foundational dermatology knowledge I had from PA school. And slowly, I figured out what actually worked.

My whole point with giving you that little background story is to say that the entire experience changed everything for me. Quite frankly, it’s why I do what I do now.

This brings me to the main point of this post: my skincare philosophy. The philosophy that healed my own skin and continues to give hundreds of my patients the glow they’re in search of.

Going through a prolonged acne flare taught me something I don’t think I could have fully understood any other way: acne is not just a skin condition. It affects your confidence, your mood, and the way you move through your day. It also taught me that more is not better. During my worst flare, I tried everything. I layered products, I over-exfoliated, I chased every new recommendation I came across. And it was only when I stripped things back and got intentional that my skin actually started to heal.

And that lesson, that stripping back and getting intentional, shows up in everything I do now. In how I build routines for patients. In how I talk about skincare online. In how I approach my own skin to this day.

Going through that experience gave me something a dermatology textbook couldn’t: I know what it actually feels like to be on the other side of the consultation room. To sit with a skin concern that’s affecting your confidence and feel like you’ve already tried everything. That empathy is something I carry into every single patient interaction, and I think it genuinely changes the way I practice.

Here are a few things I now believe deeply, both as a patient who lived it and as a provider who sees it play out every day:

1. Simplicity is always the best starting point. When a patient comes in frustrated that their “good” routine isn’t working, or that their skin is changing in ways they don’t understand, my first instinct isn’t to add something, it’s to look at what we can remove. Over-complicated routines are one of the most common culprits I see behind breakouts, irritation, and barrier dysfunction. I experienced this firsthand. The moment I stopped trying to fix everything at once and focused on a few intentional steps, my skin responded. I apply this same theory to my patient’s routines and have seen these results over and over again.

2. Consistency beats complexity EVERY. SINGLE. TIME. A three step routine done every single night will outperform a ten step routine done whenever you can manage it. I say this to patients constantly.

3. The lifestyle piece is real and it’s underrated. When I was working night shifts and running on stress and poor nutrition, no skincare product was going to fully override what was happening internally. Blood sugar, sleep, stress, diet, these things show up on your skin whether you want them to or not. I now talk about this with patients far more than I probably would have if I hadn’t experienced it myself. In fact, it’s one piece of the puzzle patients are most happy I address after years of being brushed off by other providers when they dare mention that their diet or stress could possibly be impacting their skin.

4. Patience is part of the process. This one is hard to communicate, and it’s even harder to live through. Real skin change takes time. Weeks, sometimes months. One of the most important things I try to do as a provider is help people stay the course when they feel like nothing is happening. I love to have regular check-ins even when I know they may not see changes yet. I want to cheer them on and tell them this is all expected and part of the process. Too many times people quit their routines too early when the gold is just on the other side.

But what does this all mean for a routine? How do you apply this, my years of personal experience and patient education, to an actually step by step plan for your own skin? That’s coming next for subscribers!

I just wrote a post on “if I had $300 to fix your routine.” You can read it [here]!

I want to start with something important: you do not need more than one microcurrent device.

I have three in this guide because I want to give you a complete picture of the market, but I’ll be upfront from the start: I personally use two of these daily and the third didn’t make my permanent rotation. I’ll tell you exactly why for all three. Consider this the clinical breakdown of what each device does, how they differ, and who each one is right for.

What Microcurrent Actually Does & Why I Think It’s Worth Your Time

Before we compare the devices, I want to make sure the foundation is solid, because there’s a lot of marketing noise in this space and it’s worth separating the science from the claims.

Microcurrent technology delivers low-grade electrical currents to the face — currents that mimic the body’s own natural bioelectrical signals. At the muscular level, these currents stimulate and “re-educate” facial muscles that have gradually lost tone over time. Think of it like how resistance training maintains muscle tone in the body. At the skin level, microcurrent stimulates ATP production — adenosine triphosphate, the energy currency of your cells — which supports collagen and elastin synthesis, improves circulation, and accelerates cellular repair.

The results when used consistently are real. You may notice improved facial contours, reduced appearance of fine lines, better skin tone and texture, and a general firmness that’s difficult to achieve with topicals alone. The key word is *consistently*. Microcurrent is a maintenance protocol, not a one-time treatment. Think of it like the gym — you don’t stop going after you see results, you keep going to maintain them.

One more thing worth establishing: nanocurrent, which the ZIIP uses alongside microcurrent, operates at a different frequency and penetrates at the cellular rather than muscular level, stimulating collagen and elastin production and supporting skin healing at a deeper biological layer. It’s not a marketing term — it’s a distinct mechanism, and it’s relevant to how you choose between these devices.

*Now that you know what microcurrent actually does and why the science supports it, here’s the part that matters most before you spend $300–$500: the full clinical breakdown of all three devices, the head-to-head comparison framework, and my honest bottom line on which one I’d pick if I could only keep one. That’s all below for paid subscribers.*

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I know I’m not the only one who grew up being told to air dry as much as possible and avoid hot tools whenever you can. It felt like the responsible, gentle choice. The natural one. And for a long time, most of us just accepted it as fact.

But after years of blow drying only as a guilty pleasure, I read one study and stopped air drying entirely. That was over three years ago, and I haven’t looked back.

Let me explain why.

What the Research Actually Shows

A peer-reviewed study examining the impact of different hair drying methods on hair structure found something that genuinely surprised a lot of people.

While blow drying at high heat does cause damage to the hair’s outer surface — the cuticle — air drying causes a different and arguably more significant type of damage to the inner structure of the hair. Specifically, to what’s called the cell membrane complex, or CMC — the internal scaffolding that gives hair its structural integrity and flexibility.

The mechanism makes sense once you understand it. When hair stays wet for an extended period, it swells. That prolonged swelling puts mechanical stress on the CMC from the inside, weakening the hair at a structural level that surface conditioning products can’t reach. The cuticle damage from heat is real — but it’s largely surface-level. CMC damage goes deeper.

The same study found that blow drying at a controlled distance of about 15 centimeters, using moderate heat and continuous motion, caused significantly less overall damage than air drying — and far less than high-heat blow drying at close range. Distance, heat level, and movement are the variables that matter most. Not whether you use a tool at all.

Why I Made the Switch

I want to be upfront: nothing I mention below is sponsored. I talk about the Dyson lineup because I’m a science nerd who has genuinely seen what the technology does for hair health — my own included. But the principles here apply to any quality tool with proper heat control.

Heat control is everything. The single biggest variable in how much damage a blow dryer causes is temperature consistency. Cheaper tools blast unregulated heat, which means hot spots, uneven drying, and cumulative cuticle damage over time. Quality tools with intelligent heat monitoring keep the temperature in a safe range throughout the drying process.

Your scalp needs to be dry. This is the point that gets overlooked most often in the air-dry conversation. A damp scalp left for extended periods creates an environment that can promote fungal overgrowth, dandruff, and irritation. If you’ve been struggling with scalp issues and you’re a habitual air dryer, try blow drying for a couple of weeks. Drying your scalp thoroughly and quickly is important for scalp health, not just aesthetics.

Ionizing technology changes the equation. Tools with ionizing technology break down water molecules faster, which shortens total drying time and helps smooth the cuticle as you dry rather than leaving it raised. The result is less frizz, more shine, and less overall heat exposure because the hair dries more efficiently.

Even airflow matters more than people realize. Especially for wavy or curly hair types, uneven drying — patches that dry faster than others — creates inconsistent texture and can exacerbate frizz. Consistent, even airflow gives the hair a more uniform result and reduces the time the hair spends in that vulnerable semi-wet state.

Customizable settings let you dry smarter. Fine hair needs less heat and less time. Thick hair needs more of both. A tool that lets you calibrate for your specific hair type means you’re never overdoing it — and never underdoing it either.

When Air Drying Is the Right Call

I’m not here to tell you to throw out what’s working. There are genuinely situations where air drying is the better option — and it comes down to your alternative.

If your only other option is a cheap blow dryer with no heat control that you hold directly against your hair at maximum heat? Air dry. The CMC damage from prolonged wetness is a factor, but so is the cuticle and cortex damage from uncontrolled high heat at close range. Between those two options, air drying wins.

If you’re working with a standard dryer and not ready to upgrade, here’s how to minimize damage in the meantime: use the lowest heat setting that actually dries your hair, keep the dryer at least 15 centimeters from your hair at all times, keep it moving constantly — never hold it in one spot — and always use a heat protectant before you start.

The One Product I’d Never Skip

Regardless of what tool you’re using, a quality heat protectant is non-negotiable. It creates a protective film around the hair shaft that buffers against both the thermal damage from tools and the environmental stressors your hair encounters after you leave the house. My current go-to for wet hair is Color Wow Dream Coat — it’s one of my genuine holy grail hair products because it protects while adding significant shine and frizz control. Apply it to damp hair before drying, every single time. If you’re going in with heat on already dry hair, I love this one from Living Proof.

The Bottom Line

Air drying feels like the safe, natural choice — but the science suggests it’s more complicated than that. Prolonged wetness causes internal structural damage that’s easy to overlook because it doesn’t look like the visible frizz and breakage you’d associate with heat damage. The research supports controlled blow drying — with the right tool, at the right temperature, at the right distance — as the better option for overall hair health.

If you have a quality tool with heat control and ionizing technology, use it. If you don’t, the tips above will get you closer to a safer drying routine.

Your hair will thank you either way!

Have specific hair or skin questions? My chat is open exclusively for paid subscribers where I answer all your burning questions from a Dermatology PA perspective!

I wrote an entire post on my Softwave Ultrasound Skin Tightening experience for paid subscribers! You can read it [here]!

If you’ve been following me for any amount of time, you already know that retinoids and SPF are my two non-negotiables. If I had to strip my entire philosophy down to two ingredients, it would be those, every single time. And of the two, retinoids are the one that gets the most questions — the most fear, the most confusion, the most misinformation.

So consider this the definitive retinoid post. The one I’ll point people to from now on.

What Retinoids Actually Are — And Why the Terminology Matters

“Retinoid” is the umbrella term. It covers every topical vitamin A derivative, both over-the-counter and prescription. Retinol is one type. Tretinoin is another. Retinaldehyde is another. They are not all the same thing, and treating them as interchangeable is one of the most common mistakes I see.

Here’s the conversion chain, and why it matters:

Retinol → Retinaldehyde → Retinoic Acid

Retinoic acid is the active form — the molecule that actually interacts with your skin cells to drive results. Every other form on this list has to convert to retinoic acid before it can work. The fewer conversion steps required, the faster and stronger the results — but also the higher the potential for irritation.

This is why tretinoin, which is retinoic acid, delivers faster and more dramatic results than retinol. It doesn’t need to convert. It’s already in its active form. It’s also why it requires a prescription and why I don’t recommend starting there unless a provider has recommended it.

The Retinoid Spectrum: A Clinical Breakdown

• Retinol. The most widely available and the most commonly used starting point. Requires two conversion steps to reach retinoic acid. Slower to show results, but more forgiving for beginners. Effective for fine lines, uneven tone, and minor blemishes when used consistently. The key phrase being consistently — this is a long game.

• Retinaldehyde / Retinal. One conversion step away from retinoic acid. Faster results than retinol and — counterintuitively — often better tolerated. This is my favorite recommendation for sensitive skin types who still want clinical results without a prescription. It’s having a real moment in the skincare world right now, and the clinical data warrants it.

• Adapalene 0.1% (Differin). This one deserves its own paragraph. Adapalene is a third-generation synthetic retinoid that was prescription-only for decades. It binds more selectively to retinoid receptors than retinol, which is part of why it’s so effective for acne — and why it causes less generalized irritation in many people. The fact that you can now buy it at Target for under $30 is amazing. If acne is your primary concern, this is almost always my first recommendation.

• Tretinoin (Prescription). The gold standard. Retinoic acid in its active form — no conversion required. Fastest and most clinically significant results across the board. Requires a derm provider, needs careful introduction, and is not where anyone should start. But if you’ve been using OTC retinoids consistently for 6–12 months and you’re ready to graduate, this conversation is worth having with your provider.

Who Should — & Shouldn’t — Use Retinoids

Almost everyone can benefit from a retinoid. The question is which one and how.

Retinoids are excellent for:

• Anyone in their 20s, 30s or 40s looking to prevent early signs of aging and hyperpigmentation

• Anyone dealing with breakouts, regardless of age

• Anyone with uneven texture, enlarged pores, or dullness

• Older adults addressing more pronounced fine lines, deeper pigmentation, and reduced skin density

Do not use retinoids if you are:

• Pregnant— this is a firm clinical contraindication, not a suggestion

• Dealing with active eczema, rosacea, or a significantly compromised barrier — not forever, but not right now. Get the barrier stable first, then reassess with your provider.

You now know what retinoids are and whether you should be using one. What comes next is the part most people get wrong — the exact routines, the clinical framework I use in clinic to match patients to the right strength, my exact product picks by level, and the myths I’m still hearing daily. All of that is below for paid subscribers.

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I Work in Dermatology. My Skin Was a Mess.

There’s this assumption that people in the skincare world have always had perfect skin. Like we were born with a 12-step routine in hand and never experienced a rogue cyst in our lives.

I need to dispel that myth right now — because my passion for skincare didn’t come from having great skin. It came from having really bad skin.

And honestly? I think that’s why I’m better at my job.

2015. Night shifts. Cystic acne.

I had just started my career as a Critical Care PA. Seven 12-hour night shifts in a row. Vending machine dinners. The kind of bone-deep exhaustion that makes you forget what sunlight feels like.

My skin — which had been mostly fine up to that point — started breaking out with painful, cystic pimples on my cheeks, jawline, neck, and behind my ears. I was emotionally wrecked. And my skin was, quite literally, paying the price.

Here’s what made it worse: this was 2015. Skincare content on social media was just starting to take off, but clinical voices were almost nonexistent online. There were no dermatology professionals with platforms yet. Just everyday people sharing their experiences — which I genuinely loved — but I was piecing things together with that, plus whatever I’d retained from derm rotations in PA school.

Eventually, I figured it out. And over ten years later, I’m still using the same core principles.

The 3-Step Routine That Actually Cleared My Skin

I want to be upfront: this wasn’t magic. It was consistency. And I truly believe it was the combination of these steps — not any single product — that made the difference.

That said, one of them was a game-changer I’ll shout about forever.

Step 1: Double Cleansing

I know, I know. You’ve heard me say this before. But I keep saying it because I keep watching it work.

When a patient comes to me with a solid routine that still isn’t performing, my first question is always: how are you cleansing? Because if you’re not fully removing sunscreen, makeup, and the general grime of your day, nothing else in your routine can do its job.

Double cleansing is exactly what it sounds like — two passes. The first cleanse breaks down the surface layer (SPF, makeup, sebum). The second cleanse actually cleans your skin.

First cleanse options:

• Micellar water — gentle, no-rinse option; great if you’re keeping it simple. I particularly love this option for my Combo/Oily patients.

• Cleansing balm — solid-to-oil formula that melts down and emulsifies beautifully. Great option for Normal to Dry types.

• Cleansing oil — oil dissolves oil, which means it cuts through waterproof SPF and longwear makeup like nothing else. This is your go-to if you wear a full beat.

Second cleanse — matched to your skin type:

• Oily/acne-prone: a gentle AHA/BHA gel cleanser

• Dry/sensitive: a fragrance-free, barrier-supportive wash

• Normal: something lightweight with ceramides to maintain your barrier

This step alone decongested my pores and made every product I applied afterward actually absorb the way it was supposed to.

Step 2: The Heavy Lifter — Peel Pads

If I had to credit one single product for turning my skin around, it’s peel pads.

Not a prescription. Not an expensive treatment. Peel pads.

They didn’t just stop my breakouts — they also smoothed my texture, evened my tone, and faded the post-inflammatory hyperpigmentation (PIH) that was truly haunting me. Those dark marks that linger long after the pimple is gone? Peel pads were the thing that finally moved the needle.

I fall in love with them again every single time I come back to them. That’s not exaggeration — that’s ten years of consistent results talking.

Another option here is a heavy-hitting retinoid like Adapalene. Both work. Pick only one. At the time I hadn’t even heard of adapalene yet, so peel pads became my saving grace.

(My specific picks are linked in my ShopMy — I’ll always link exactly what I use and recommend for every skin type)

Step 3: Daily SPF — The Step I Was Skipping

This one is embarrassing to admit given my field, but: before 2015, I was only applying sunscreen at the beach.

If you have post-acne marks — the dark spots left behind after a breakout — sun exposure makes them darker and makes them last significantly longer. UV exposure triggers melanin production, and already-inflamed skin produces more of it. Daily SPF isn’t optional when you’re trying to clear PIH. It’s the thing that makes everything else work.

I made tinted SPF my final, non-negotiable step. Every day. No exceptions. A tinted SPF became my “no-makeup” makeup.

This was the piece that sealed it.

In Conclusion…

I share this because I remember what it felt like to stare in the mirror and wonder if my skin would ever calm down. The exhaustion of trying things that didn’t work. The hit to your confidence that nobody really prepares you for.

I’m not promising you’ll

have my exact result. Skin is individual — that’s something I believe deeply. But consistent, evidence-based skincare works. And knowing why each step matters makes you infinitely more likely to stick with it.

🔒 Paid subscribers: Got questions about your own acne routine — what to add, what to cut, whether peel pads are right for your skin type? This is exactly what I use the chat for. Drop your question there and I’ll answer it personally.

Join the conversation →

New here? My post for paid subscribers on How To Build A Skin Routine is the best place to start — it cuts through the noise and tells you exactly what your routine actually needs.

Everywhere you look right now, there’s another “celebrity filler fail” breakdown circulating online. Social media has decided filler is the villain of modern aesthetics, and as someone who performs injectables every day, I can tell you that narrative is both misleading… and still pointing to something very real.

Filler isn’t disappearing. But the filler-first era of aesthetic medicine is ending.

Over the past two years in clinical practice, I’ve watched treatment plans quietly flip. Consultations that once began with “Where should we add volume?” now begin with conversations about skin quality, collagen integrity, and long-term tissue support. Patients aren’t necessarily asking for more procedures, they’re asking for smarter sequencing. They want to look refreshed, not transformed. Recognizable, not optimized into someone else’s face.

This shift isn’t happening because filler suddenly stopped working. In skilled hands, hyaluronic acid fillers remain one of the most elegant tools we have. What has changed is the aesthetic goal itself. The overly sculpted cheekbones, ultra-snatched jawlines, and exaggerated proportions that defined the last decade are quietly losing favor, replaced by a preference for results that are subtle, cumulative, and nearly undetectable. In other words, aesthetic medicine is moving away from volume-driven transformation and toward tissue-quality optimization.

And that philosophical shift is exactly why energy-based devices are stepping into the spotlight.

Energy-based devices are not new. They’ve been around longer than many injectables, but fresh technology is hitting the market all the time. And here’s why they’re the way of the future:

Devices work with what you’ve already got. Nothing is being added. Most of these devices work on the premise of collagen stimulation not volume replacement. They do this, mostly, by mechanism of controlled injury. Through heat, ablation, ultrasound etc these device stimulate your skin to create a “healing” response and create more collagen and elastin, the proteins found deep within our skin that are largely responsible for its structure and youthful appearance. This approach lends itself to tissue quality over structural change. In layman’s terms, these devices increase skin integrity, it’s “bounce back”, the life force that makes youthful skin so appealing in the first place. They do not add density to our cheek bones or make our lips plump and juicy with added volume. I find this new wave of cosmetic treatments especially popular amongst my younger patients which is incredibly fitting. Starting with these devices in our 30s and early 40s, when we’re only just beginning to see the effects of diminishing collagen and structural integrity of the skin, will lead to the most impressive results. The earlier you can intervene this process and start “banking” your collagen the better. Now, I don’t want this to be misconstrued as a “preventative botox” type situation where I’m encouraging 20 year olds to spend their money on cosmetic procedures. I’m simply saying don’t want until you’re very unhappy with major skin changes because at that point, surgery may be your best option (no shade to surgery btw, your girl will be first in line when the time comes).

Why this shift is happening now: we’ve already covered the social media backlash of over-filled faces. We are now in the era of “undetectable work”. This is the true quiet luxury of the aesthetics world. Having the look of being “refreshed” without a massive transformation is overpowering the dramatic before and after. Aesthetic medicine follows the trends of other areas, and in this case, cosmetics is following the lead of longevity medicine. Somewhere along the line we all got obsessed with blood sugar balance, walking 10k steps a day, hyperbaric oxygen and red light. Why? Because we have a deep desire to chase immortality (a topic for another day), and the aesthetic medicine patient is not immune. Regenerative medicine is the way of the future and in our industry that means stimulating our skin to do what it {used to do} best- create collagen, elastin, hyaluronic acid and all the other proteins and glycosaminoglycans that make us look glowing and radiant.

If you work in aesthetics, here’s what this means for your practice:

* You must invest in collagen-stimulating platforms. The consumer is smarter now than ever before and will not just be sold whatever laser or antiquated device you happen to have on hand.

* It’s time to train your staff to discuss tissue quality if they aren’t already.

* Position your injectable offerings as refinement, not the foundation. These are the cherry on top after you’ve seen what results you’ve accomplished with your energy devices.

While injectables used to be the first line of treatment, I believe they will now become the cherry on top, if they’re used at all. The new aesthetic treatment pyramid will look something like this:

Old Model

1. Neuromodulators like Botox and Dysport

2. Hyaluronic Acid Fillers

3. Lasers (optional)

4. The other devices and biostimulators were more of an afterthought.

New model

1. Skin quality (energy devices, lasers)

2. Structural collagen stimulation

3. Conservative injectables as finishing touches

Where Aesthetic Medicine Is Headed Next

Aesthetic medicine isn’t becoming less popular, it’s becoming more sophisticated.

Over the next five years, we’re likely to see a continued shift away from syringe-centered treatment plans and toward strategies built around collagen preservation, tissue regeneration, and long-term skin quality. Device memberships and subscription-style treatment models will become more common, combination “stacking” protocols will replace one-off procedures, and patients will increasingly expect treatment plans designed around cumulative results rather than single dramatic visits.

Injectables will absolutely remain part of the aesthetic landscape, but their role is evolving. Instead of serving as the foundation of most treatment plans, they will increasingly function as refinement tools — the final 10–15% that enhances an already strong structural and skin-quality base created through regenerative and energy-based treatments.

Practices that recognize this shift early will lead the next era of aesthetics. Those that continue relying primarily on volume-based transformations may find themselves increasingly out of step with a patient population that is more educated, more longevity-focused, and far less interested in looking “done.”

For patients, the takeaway is simple: the future of aesthetic medicine isn’t about adding more — it’s about preserving more. Preserving collagen. Preserving structure. Preserving the recognizable version of yourself that you still want to see in the mirror ten years from now.

And that is exactly why devices are no longer an optional add-on. They are quickly becoming the foundation. Want my entire Microcurrent Guide? I just wrote a full article for paid subscribers [here]!

This scenario plays out in my clinic more than you’d think. A patient comes in with a seven-step skincare routine, a handful of other products collecting dust on their shelf, and hundreds of dollars already spent. Great products, seemingly. And still, their skin isn’t where they want it to be. If that’s you, I see you. And I want to show you exactly how I’d approach fixing it.

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Nothing says “I’m uneducated on skincare” like immediately dismissing a routine or product because of where it was sold. Yet, it happens all the time in the industry. And I’m not just calling out estheticians here. This happens across the field- Dermatologists, PAs, NPs, MAs. I’ve spoken to enough patients who have been through the motions at other clinics, med Spas and the like to know that this rhetoric is alive and well in most professional offices.

I love the moment when I tell a fellow professional that the retinol I’m currently using is from Sephora — a 1% encapsulated formulation that’s both highly effective and gentler on the skin barrier. Or that my sunscreen is from Target, because it’s a beautiful blend of chemical and mineral filters that offers superior protection, a cosmetically elegant finish, and doubles as a primer under my skin tint. The look on their face says everything.

Before I worked in dermatology, I treated myself to a facial at one of the most well-regarded clinics in Miami. My acne was finally under control and I wanted a self-care moment. I won’t name names.

During the facial, the esthetician noticed some post-inflammatory hyperpigmentation and asked what I’d been using. I walked her through my routine — simple, intentional — and she zeroed in on my Dr. Dennis Gross Peel Pads. She told me I should stop using them and switch to a similar product from their office that was “more effective.”

I politely declined.

And when I left, I made a quiet vow: always take professional opinions with a grain of salt when they conveniently align with a product sale.

Here’s why: those peel pads had single-handedly cleared my acne. They were actively fading my hyperpigmentation. It was the one thing I had changed in my routine, and the difference was undeniable. No one was going to talk me out of something that was clearly working, not without a compelling clinical reason (or any reason at all).

I say this to warn you: while I think it’s very important to seek the help of a professional when you’re struggling with your skin, you also know your skin better than anyone.

If something is working for you, push back. Insist on keeping it. Or ask for a true explanation of why they think it may not be working for your skin. The best providers will build around what’s already working rather than bulldoze it. They should also have the clinical knowledge to explain their reasoning in detail, beyond just what a skincare sales rep told them.

When patients do this in my clinic, I welcome it. Even if I’m skeptical of a product, I’ll keep it in the routine and check back in four weeks to see how the skin is responding. If I know a product isn’t working I will give my honest reasoning and let the patient decide.

Here’s where things get a little spicy. When you go in for a facial or a skin consultation and mention you’re using drugstore or Sephora products, you might hear something like:

• “Those products don’t use the same quality ingredients as medical grade.”

• “Medical grade formulations are allowed to use higher percentages of active ingredients.”

• “But only these medical grade brands conduct actual clinical studies.”

All of this is categorically false. And the term “medical grade” itself? Made up.

In the United States, skincare products fall into exactly two regulatory categories: cosmetics/cosmeceuticals and drugs. Cosmetics are what you find at beauty retailers. Drug formulations are what list an “active ingredient” with a percentage on the back of the bottle. That’s it.

“Medical grade” is not a regulatory category. It’s not an FDA designation. It’s a marketing term, one that any brand can apply to themselves when pitching to dermatologist offices and med spas. That same brand could pivot tomorrow and sell at Ulta. The label means nothing from a regulatory standpoint. Usually they’ll tell you something along the lines of:

• “Skin care you get at the drugstore. Legally can’t have higher percentages of certain ingredients like ‘medical grade.’”

• “Products you buy at Sephora can’t make a real difference in your skin.”

To be fair, this isn’t entirely the fault of the individual provider. This rhetoric has been passed down from mentor to mentee for decades in the skincare industry. And the reason is pretty straightforward: they need to justify the price point.

If you come in with a $28 cleanser from Trader Joe’s that’s working, they need a reason to sell you a $95 one instead. “Medical grade” is that reason, even if it’s just positioning.

Let me be clear: there are genuinely excellent products sold exclusively through dermatology offices. Some of my favorites live in that category. But I have just as many favorites that you can pick up at the drugstore for a fraction of the cost that can work just as well, sometimes better. Where a product is sold should never be the determining factor in whether it belongs in your routine.

What actually matters is the formulation, the ingredients, the concentration, and whether it’s right for your skin.

If you’re a consumer: Find a provider who will actually listen, who will say no when they need to, respect what’s already working for you, and be honest when they’re unsure about an ingredient instead of defaulting to whatever they’re selling. That kind of provider exists. Don’t settle for less.

If you’re a provider: We are in the business of helping people, not earning commission on skincare. It is your responsibility to pursue education beyond what your brand reps tell you. Recommending a $15 product from Target when it’s the right call is not a failure. It’s integrity. Don’t let outdated mentorship shrink what you’re willing to learn.

I just wrote an article for paid subscribers on “If I Had $300 To Fix Your Routine.” You can read it [here]!

Part 1: Drugstore & Mass Market Picks

Clinically effective. Accessible. Often a fraction of the cost of their prestige equivalents.

• CLEANSERS:

  • Cetaphil Gentle Skin Cleanser

    • This is where I start for almost every sensitive, compromised, or post-procedure patient. It’s one of the most well-tolerated cleansers on the market. Why? It’s non-stripping, fragrance-…

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For years, retinoids have been demonized. “They thin the skin, they age the skin, they cause inflammation. They make your skin more sensitive to the sun. You’ll end up with more damage from using them,” they say. These are some of the most common myths cited by those who aren’t as privy to skincare knowledge. And while you will almost never hear a dermatologist or dermatology provider encouraging you to avoid retinoids for any of these reasons, it does seem to be spouted often by those in the clean beauty space, especially those who are selling product.

As someone who’s moderately crunchy myself, I do see the benefit of a simple skincare routine. But it needs to use effective ingredients if you want it to actually be effective.

Recently, Dr. Barbara Sturm has been under significant heat from the dermatology space after being featured in a Wall Street Journal article titled “This Skincare Mogul Says You Only Need Two Products for Healthy Aging.” In it, she was quoted advocating against retinoids, claiming they thin the skin, increase inflammation, and damage the barrier. Her recommendation? A hyaluronic acid serum and a face cream, conveniently, the two hero products of her $300+ skincare line. She also made headlines for being, as the WSJ put it, “pro-natural sunlight.”

Let’s unpack all of this.

1. The “Retinoids Thin the Skin” Claim

This is the one that made dermatologists’ heads collectively explode, and for good reason. It is the opposite of what the clinical data shows.

Retinoids work by stimulating collagen production in the dermis, the deeper layer of the skin. With consistent use, they thicken the dermis over time, improving firmness and elasticity. What Sturm may be conflating is the fact that retinoids do exfoliate the surface layer of dead skin cells, the stratum corneum, which could technically be described as “thinning” one layer. But this is the same layer that naturally sheds itself anyway. The net effect of retinoid use on the skin as a whole? Thicker, stronger, more resilient skin. This isn’t a matter of opinion, it’s one of the most replicated findings in dermatological research.

Her own brand’s FAQ doubles down: retinoids, it states, “reduce the natural protective barriers of your skin by killing healthy skin cells and stripping the surface layers away.” This language is designed to alarm you, and it’s not accurate.

2. The “Retinoids Cause Inflammation” Claim

Here’s where context matters, and where I’ll give a partial nod to nuance before disagreeing.

Yes, retinoids can cause what’s called retinoid dermatitis, particularly when introduced too quickly, at too high a concentration, or without a proper supporting routine. Dryness, flaking, and temporary redness are real and common, especially in the first few weeks of use. This is not a reason to avoid retinoids. It’s a reason to use them correctly.

The irony here is that Sturm’s anti-inflammatory positioning is actually solid, inflammation absolutely does drive skin aging, and managing it matters. But retinoids, used properly, are themselves anti-inflammatory in the long run. They regulate cell turnover, reduce acne-causing congestion, and improve the skin’s overall resilience against environmental stressors. The initial adjustment period is not the same as chronic inflammation. Confusing the two is either a misunderstanding of the science or a convenient one.

3. The “You Only Need Two Products” Claim

A hyaluronic acid serum and a face cream. That’s it, according to Sturm.

Hyaluronic acid is a genuinely useful humectant, it draws water to the surface of the skin and supports hydration. A good barrier cream can absolutely be a meaningful part of a routine. I am not arguing against either of these things.

What I am arguing against is the suggestion that this is sufficient for “healthy skin aging.” Or that it replaces the clinical evidence behind ingredients like retinoids, vitamin C, and SPF. Hyaluronic acid hydrates. It does not build collagen in a meaningful way. It does not fade hyperpigmentation. It does not protect against UV damage. It does not address cell turnover or skin renewal in a clinical way.

What this recommendation does do? Sell a $300 hyaluronic acid serum and a $310 face cream to people who are now afraid of every other ingredient that actually does the heavy lifting.

4. The “Pro-Natural Sunlight” Take

This one is perhaps the most medically irresponsible claim in the article, and it generated the loudest response for that reason.

Ultraviolet radiation is the single most evidence-backed driver of premature skin aging and skin cancer. The case for daily broad-spectrum SPF use is not a matter of debate in dermatology, it is the closest thing we have to a universal consensus in the field. Suggesting that natural sunlight is beneficial to aging skin, without a strong SPF caveat, is not a wellness perspective. It is a public health concern.

Why This Matters

Sturm is not alone. She is one of the most high-profile examples of a pattern that is alive and well in the skincare industry: a premium brand founder using fearmongering about clinically validated ingredients to drive customers toward their own products.

This is the same playbook we’ve discussed before, the “medical grade is made up” conversation, the derm office that tells you your Sephora products aren’t working, the esthetician who tells you to throw out your peel pads. The common thread is always the same: create distrust of what you already have, and sell you something that costs more.

Here’s what I want you to take away from this. Retinoids are one of the most studied, most replicated, most clinically validated categories of skincare ingredients that exist. The evidence behind them spans decades, multiple formulations, and thousands of peer-reviewed studies. You do not need a $300 hyaluronic acid serum. You do not need to fear your adapalene. And you absolutely need to wear SPF.

The best skincare routine is the one that uses ingredients with clinical evidence behind them, applied correctly, at an appropriate frequency for your skin type — regardless of the price point, the brand, or who’s telling you what to be afraid of.

I cover exactly this — the ingredients that actually work and why — for paid subscribers. If you’re ready to cut through the noise for good, consider joining below. 👇